Provider Demographics
NPI:1336785518
Name:SUN VALLEY RECOVERY
Entity Type:Organization
Organization Name:SUN VALLEY RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-310-2874
Mailing Address - Street 1:2600 E SOUTHERN AVE STE I-3
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5413
Mailing Address - Country:US
Mailing Address - Phone:480-310-2874
Mailing Address - Fax:
Practice Address - Street 1:2600 E SOUTHERN AVE STE I-3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5413
Practice Address - Country:US
Practice Address - Phone:480-310-2874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)